Paeds · professional-practice-and-evidence
Breaking bad news and serious-illness communication
Also known as Breaking bad news in paediatrics · Serious-illness conversation · SPIKES protocol for children · Goals-of-care and advance care planning communication · Prognostic disclosure to children and families
Fellowship guide to breaking bad news and serious-illness communication in paediatrics: SPIKES, Ask-Tell-Ask and NURSE; goals-of-care and advance care planning; prognostic disclosure adapted to the child's development; managing hope, conflict and end-of-life transitions; clinician debrief; and ANZ/UK/US/Canada system and cultural differences.
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Target exams
Red flags
- Delivering a new diagnosis standing in a corridor or beside a busy nurses' station
- Colluding with false hope so disease-directed treatment continues against the family's real goals
- Excluding the child or adolescent from every conversation about their own illness
- No interpreter present for a family with limited English proficiency
- Giving information without checking understanding or arranging follow-up
- Ignoring clinician moral distress after repeated unstructured difficult conversations
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Communication skills and professional practice
- Renewed curriculum — Learning goal 12: Communication with patients, families, and health professionals
- Palliative care and serious illness
- Professional practice and ethics
- Written assessment of professional practice and communication
- Communication stations
- Long Cases involving serious illness
- Structured discussion of breaking bad news
- 2. Professional skills and knowledge: Communication
- Safeguarding and palliative care themes
- Leadership and team working
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Communication
- History taking and management
- Child development
- General Pediatrics Content Outline — communication and palliative care
- General Pediatrics EPA: Leading a family meeting and breaking bad news
- Bioethics and professional conduct
- Interpersonal and Communication Skills
- Patient Care: palliative and end-of-life communication
- Professionalism
- Communicator
- Collaborator
- Professional
- Health Advocate
- Pediatrics EPA — leading difficult conversations
Two things that get mixed up
Breaking bad news
- A single, structured conversation delivering information that alters a person's expectations about their present or future — a new diagnosis, relapse, poor prognosis or error. SPIKES is the workhorse. The job is to share accurate information with empathy and to leave the family supported.
Serious-illness communication
- The broader, longitudinal skill of talking with children and families across an illness: values and goals, prognostic uncertainty, advance care planning, and transitions to palliative care. The Serious Illness Conversation Guide belongs here. Breaking bad news is one event within it.
Setting (private, right people, phones away, tissues, interpreter) · Perception (what do they already know?) · Invitation (how much do they want to hear now?) · Knowledge (headline warning, then plain language with pauses) · Empathy (respond to emotion; use NURSE) · Strategy and summary (agree a plan, written summary, follow-up). [1] [3]
Overview & Definition
A six-year-old is admitted overnight with pallor and bruising. The morning blood film shows blasts. By midday both parents are in a side room with you. What you say next — and how you say it — will be remembered by this family for the rest of their lives. That is breaking bad news. [1] [3]
Breaking bad news means conveying information that adversely and materially alters a person's expectations about their present or future. In paediatrics the patient is a child embedded in a family, so the conversation is almost always held with parents and, developmentally, with the child or young person. The dominant teaching structure is the SPIKES six-step protocol, first described for adults with cancer and now adapted across paediatrics. [1]
Serious-illness communication is the larger, longitudinal craft this page also owns: values and goals, prognostic uncertainty, advance care planning, and the shift from cure-directed to comfort-focused care. Tools such as the Serious Illness Conversation Guide (and its paediatric adaptation) structure these talks. Breaking bad news is one event inside that longer conversation. [12] [13]
This page owns the process and skills. Cross-link dedicated leaves for consent and mature-minor frameworks, shared decision-making, communicating risk and uncertainty, open disclosure, conflict, trauma-informed care and working with interpreters — do not rebuild their content here. [3]
References15ShowHide
- [1]Baile WF SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. The oncologist, 2000.PMID 10964998
- [2]Back AL Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Archives of internal medicine, 2007.PMID 17353492
- [3]Levetown M Communicating with children and families: from everyday interactions to skill in conveying distressing information. Pediatrics, 2008.PMID 18450887
- [4]Wolfe J Symptoms and suffering at the end of life in children with cancer. The New England journal of medicine, 2000.PMID 10655532
- [5]Contro NA Hospital staff and family perspectives regarding quality of pediatric palliative care. Pediatrics, 2004.PMID 15520103
- [6]Mack JW Early integration of pediatric palliative care: for some children, palliative care starts at diagnosis. Current opinion in pediatrics, 2006.PMID 16470155
- [7]Arnold RM The Critical Care Communication project: improving fellows' communication skills. Journal of critical care, 2015.PMID 25535029
- [8]Kaye EC Prognostic Communication Between Oncologists and Parents of Children With Advanced Cancer. Pediatrics, 2021.PMID 33952691
- [9]Ilowite MF Disparities in prognosis communication among parents of children with cancer: The impact of race and ethnicity. Cancer, 2017.PMID 28873224
- [10]Sisk BA Prognostic Disclosures to Children: A Historical Perspective. Pediatrics, 2016.PMID 27561728
- [11]Kamihara J Parental hope for children with advanced cancer. Pediatrics, 2015.PMID 25847801
- [12]van Breemen C Serious Illness Conversations in Pediatrics: A Case Review. Children (Basel, Switzerland), 2020.PMID 32824811
- [13]Doherty M The Pediatric Serious Illness Conversation Program: Understanding challenges and experiences for clinicians after advance care planning training. Palliative & supportive care, 2024.PMID 37288722
- [14]Davidson JE Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU. Critical care medicine, 2017.PMID 27984278
- [15]Ryan RE Interventions for interpersonal communication about end of life care between health practitioners and affected people. The Cochrane database of systematic reviews, 2022.PMID 35802350